Performance of the Mini Nutritional Assessment Score in the Detection of Vitamin D Status in an Elderly Greek Population

The primary aim of the study was to explore the potential relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and Mini Nutritional Assessment (MNA) score, a surrogate for protein energy undernutrition, in elderly (≥65 years old) subjects with and without a hip fracture. A secondary aim of the study was to provide estimates of the MNA discriminatory performance in the detection of subjects with low levels of 25(OH)D (<20 ng/ml). The study population consisted of 101 patients with a hip fracture, recruited from a single urban Hospital in Athens, Greece, and 85 community dwelling subjects with no history of hip fracture. Serum 25(OH)D was measured, nutritional status was determined by the MNA questionnaire in all subjects, and linear correlation between variables was investigated. Receiver operator characteristic (ROC) curve analysis was performed and discriminatory performance was further assessed by calculating positive and negative likelihood ratios (LR). MNA scores were significantly correlated with 25(OH)D levels (rho=0.685, p<0.001) and this finding was robust in both groups and unaffected by gender. ROC curve analysis demonstrated an area under the curve (AUC) of 0.860 [standard error (SE): 0.026, 95% confidence interval (CI): 0.810–0.910], which provided a significantly better estimation of 25(OH)D status than simple guess (p<0.001). The lowest cutoff value in MNA score, providing a sensitivity over 90% was 25.25, which was associated with a sensitivity of 90.9% and a specificity of 53.6%. The same analysis revealed acceptable results only within hip fracture patients. MNA score might be a satisfactory surrogate marker for 25(OH)D levels with which it is linearly correlated. However, it appears that its discriminatory performance, as a diagnostic tool for 25(OH)D insufficiency, is rather suboptimal.

Key words

25-hydroxyvitamin D [25(OH)D] - mini nutritional assessment - undernutrition - hip fracture - aging - osteoporosis

• References

• 1 Cauley JA, Lacroix AZ, Wu L, Horwitz M, Danielson ME, Bauer DC, Lee J, Jackson RD, Robbins JA, Wu C, Stanczyk FZ, LeBoff MS, Wactawski-Wende J, Sarto G, Ockene J, Cummings SR. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 2008; 149: 242-250
• 2 Dumitrescu B, van Helden S, ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G, van der Linden S, Geusens P. Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskelet Disord 2008; 9: 109
• 3 Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011; 96: 53-58
• 4 Premaor MO, Alves GV, Crossetti LB, Furlanetto TW. Hyperparathyroidism secondary to hypovitaminosis D in hypoalbuminemic is less intense than in normoalbuminemic patients: a prevalence study in medical inpatients in southern Brazil. Endocrine 2004; 24: 47-53
• 5 Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature – What does it tell us?. J Nutr Health Aging 2006; 10: 466-485 discussion 467–485
• 6 Toulis KA, Iliadou PK, Venetis CA, Tsametis C, Tarlatzis BC, Papadimas I, Goulis DG. Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies. Hum Reprod Update 2010; 16: 713-724
• 7 Dunnigan MG, Henderson JB, Hole DJ, Barbara Mawer E, Berry JL. Meat consumption reduces the risk of nutritional rickets and osteomalacia. Br J Nutr 2005; 94: 983-991
• 8 Corino A, D’Amelio P, Gancia R, Del Rizzo P, Gabasio S, Limone P, Isaia G. Hypovitaminosis D in internal medicine inpatients. Calcif Tissue Int 2007; 80: 76-80
• 9 Shardell M, Hicks GE, Miller RR, Kritchevsky S, Andersen D, Bandinelli S, Cherubini A, Ferrucci L. Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci 2009; 64: 69-75